Systems and methods for treating pulmonary edema

ABSTRACT

Various systems and methods are provided for treating pulmonary edema. In general, a pump can be configured to be implanted within a patient at risk of developing edema. The pump can be configured to pump fluid out of the patient’s lungs, e.g., out of the patient’s interstitial and alveolar spaces. The pump can be configured to be fully implanted within the patient’s body. The pump can be configured to continuously pump fluid, or the pump can be configured to be selectively actuatable in response to a trigger event. In an exemplary embodiment, the pump can include an inflow port coupled to an inflow tube in fluid communication with a lymphatic vessel of the patient, and can include an outflow port coupled to an outflow tube in fluid communication with a vein of the patient.

CROSS REFERENCE

The present application claims priority to U.S. Provisional Pat.Application No. 62/006,206 entitled “System And Method For Treatment ofPulmonary Edema” filed Jun. 1, 2014, which is hereby incorporated byreference in its entirety.

FIELD

The present disclosure relates generally to systems and methods fortreating pulmonary edema.

BACKGROUND

The lymphatic system is part of the circulatory system in conjunctionwith the arterial and venous systems. A primary function of thelymphatic system is to drain excessive interstitial fluid back into thevenous system at two main locations: the thoracic duct and the lymphaticduct, which drain into the left and right subclavian veins,respectively.

Under normal circulatory conditions of the arterial and venous systemsthe interstitial fluid volume balance is maintained and the lymph fluidis cleared back through the lymphatic system. In pathological conditionssuch as Acute Cardiogenic Pulmonary Edema and chronic heart failure, thecapillary hydrostatic pressure and the venous pulmonary pressure canbecome elevated and fluid flows excessively out of the blood vessels andinto the interstitial and alveolar spaces. The pressure gradient betweenthe initial lymphatics and at the outflow of the thoracic duct and thelymphatic duct is reduced and the lymphatic system cannot clear theadditional fluid which accumulates in the air spaces of the lungs. Thisis a life threatening condition as gas exchange is impaired to theextent that it may lead to respiratory failure.

Current treatment methods require extended hospitalization and treatmentwith loop diuretics and/or vasodilators. Oftentimes patients must alsoreceive supplemental oxygen or, in more extreme cases, requiremechanical ventilation. Many of these treatment methods are less thanideal because the edema is not always alleviated rapidly enough and formany patients renal function is adversely affected. A significantpercentage of patients do not respond to this treatment and asignificant percentage must be readmitted to a hospital within 30 days.

A significant problem with current treatment protocol is that it isbased on the need to reduce intravascular blood pressure to movelymphatic fluid back into the vasculature. The reduction ofintravascular blood pressure leads to leads to hypotension and activatesthe Renin Angiotenesin Aldesterone System, which leads to an increase inblood pressure. Eventually, this cycle leads to diuretic resistance andthe worsening of renal function in almost 30% of admitted patients.

Accordingly, there remains a need for improved methods and devices forsystems and methods for treating pulmonary edema.

SUMMARY

Various systems and methods are provided for treating pulmonary edema.In one embodiment a system for treatment of edema includes a pumpconfigured to be implanted in a body of a patient, an inflow tubefluidically coupled to an inflow port of the pump and configured to beimplanted into the body of the patient so as to bring the inflow portinto fluid communication with a lymphatic vessel of the patient, and anoutflow tube fluidically coupled to an outflow port of the pump andconfigured to be implanted into the body of the patient so as to bringthe outflow port into fluid communication with a vein in the body of thepatient such that the pump is operative to pump fluid from the lymphaticvessel to the vein.

The system can vary in any number of ways. For example, the system caninclude a controller configured to actuate the pump. The controller canbe configured to actuate the pump in response to user operation of acontrol external to the body of the patient, and/or the system caninclude a pressure sensor configured to be implanted in the body of thepatient. The controller can be configured to actuate the pump inresponse to a pressure measured by the pressure sensor exceeding apredefined threshold, and/or the controller can be configured to controla speed of operation of the pump depending on a pressure measured by thepressure sensor.

For another example, the pump can be configured to continuously pump thefluid from the lymphatic vessel to the vein.

For yet another example, the system can include a power sourceconfigured to be implanted in the body of the patient and configured toprovide power to the pump.

For another example, the system can include a charging coil configuredto inductively couple to a power source external to the body of thepatient and thereby provide power to the pump.

For yet another example, the pump can be configured to pump fluid at arate in a range of about 10 to 1000 ml/hour, e.g., in a range of about10 to 200 ml/hour.

In another aspect, a method is provided that in one embodiment includesimplanting a pump in a body of a patient, the pump being operable toconvey a bodily fluid from an inflow port of the pump to an outflow portof the pump, arranging a first tube in fluid communication with theinflow port to be in fluid communication with a lymphatic vessel of thepatient, and arranging a second tube in fluid communication with theoutflow port to be in fluid communication with a vein of the patientsuch that the pump is operable to convey fluid from the lymphatic vesselto the vein.

The method can have any number of variations. For example, the methodcan include actuating the pump, thereby causing the pump to convey thefluid, e.g., lymph, from the lymphatic vessel to the vein of thepatient. The actuated pump can maintain an outflow pressure in a rangeof about 2 to 6 mmHg, the pump can be actuated in response to useroperation of a control external to the body of the patient, and/or thepump can be configured to be actuated periodically or continuously.

For another example, the lymphatic vessel can include one of a thoracicduct of the patient and a lymphatic duct of the patient.

For yet another example, the vein can include one of the patient’ssubclavian vein, internal jugular vein, innominate vein, and superiorvena cava.

For still another example, the method can include implanting a pressuresensor in a location within the body of the patient that enables thepressure sensor to measure pressure in a desired region of the body ofthe patient. The method can include measuring the pressure in thedesired region using the pressure sensor, and actuating the pump inresponse to the measured pressure exceeding a predefined thresholdand/or controlling a speed of operation of the pump depending on themeasured pressure.

For another example, the pump can be implanted adjacent to one of ajunction of the patient’s left subclavian vein and internal jugular veinand a junction of the patient’s right subclavian vein and internaljugular vein.

For yet another example, the pump can include a power source, and themethod can include recharging the power source by inductive coupling toa power source external to the body of the patient.

For another example, the pump can include a power source, and the methodcan include recharging the power source by inductive coupling to a powersource external to the body of the patient.

For still another example, the method can include advancing a wire intothe body of the patient and into the lymphatic vessel, verifying theposition of the wire within the lymphatic vessel, and then arranging thefirst tube.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of an embodiment of an implantable pumpimplanted in a body;

FIG. 2 is a perspective view of the implanted pump of FIG. 1 ;

FIG. 3 is a perspective view of an implantable power source implanted inthe body of FIG. 1 and in electronic communication with the pump of FIG.1 ;

FIG. 4 is a schematic view of an embodiment of a control system for apump configured to facilitate treatment of edema;

FIG. 5 is a perspective view of another embodiment of an implantablepump implanted in a body;

FIG. 6 is a perspective view of yet another embodiment of an implantablepump implanted in a body;

FIG. 7 is a perspective view of another embodiment of an implantablepump implanted in a body;

FIG. 8 is a perspective view of still another embodiment of animplantable pump implanted in a body;

FIG. 9 is a perspective view yet still another embodiment of animplantable pump implanted in a body;

FIG. 10 is a perspective view of an embodiment of an implantablerestrictor;

FIG. 11 is a perspective view of the restrictor of FIG. 10 implanted ina body and in an activated configuration;

FIG. 12 is a perspective view of the restrictor of FIG. 11 implanted inthe body and in a relaxed configuration;

FIG. 13 is a perspective view of another embodiment of an implantablerestrictor;

FIG. 14 is a flowchart of one embodiment of a method of treatingpulmonary edema using an implanted pump;

FIG. 15 is a flowchart of one embodiment of a method of controllingfluid flow using the pump in the method of FIG. 14 ; and

FIG. 16 is a flowchart of another embodiment of a method of controllingfluid flow using the pump in the method of FIG. 14 .

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one embodiment,” or “an embodiment,” or the like, meansthat a particular feature, structure, or characteristic described inconnection with the embodiment is included in at least one embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one embodiment,” or “in an embodiment,” or the like,in places throughout the specification are not necessarily all referringto the same embodiment. Furthermore, the particular features,structures, or characteristics may be combined in any suitable manner inone or more embodiments. Thus, the particular features, structures, orcharacteristics illustrated or described in connection with oneembodiment may be combined, in whole or in part, with the featuresstructures, or characteristics of one or more other embodiments withoutlimitation.

It will be appreciated that the terms “proximal” and “distal” may beused throughout the specification with reference to a clinicianmanipulating one end of an instrument used to treat a patient. The term“proximal” refers to the portion of the instrument closest to theclinician and the term “distal” refers to the portion located furthestfrom the clinician. It will be further appreciated that for concisenessand clarity, spatial terms such as “vertical,” “horizontal,” “up,” and“down” may be used herein with respect to the illustrated embodiments.However, surgical instruments may be used in many orientations andpositions, and these terms are not intended to be limiting and absolute.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the anatomy of the subject in which the systems and devices will beused, the size and shape of components with which the systems anddevices will be used, and the methods and procedures in which thesystems and devices will be used.

Various systems and methods are provided for treating pulmonary edema.In general, a pump can be configured to be implanted within a patient atrisk of developing edema. The pump can be configured to pump fluid outof the patient’s lungs, e.g., out of the patient’s interstitial andalveolar spaces, which can help prevent the fluid from building up to adangerous degree. The pump can thus be configured to facilitateprevention of edema by limiting fluid build-up in the lungs, if notpreventing fluid build-up entirely. In other words, the pump can beconfigured to facilitate treatment of chronic edema, such as can occurin connection with chronic heart failure. The pump can be configured tofacilitate higher lymphatic return by lowering outflow pressure at alymphatic vessel of the patient, e.g., at the patient’s thoracic ductand/or lymphatic duct. The pump can be configured to be fully implantedwithin the patient’s body, thereby helping the device to be unobtrusivein the patient’s daily life, similar to a pacemaker. The pump can beconfigured to continuously pump fluid, which can help ensure the removalof fluid that collects in the lung space before a dangerous amount ofthe fluid builds up and/or can help ensure the long term patency of thepump. In other words, the pump can be configured to continuously run andprovide fluid flow. Alternatively, the pump can be configured to beselectively actuatable in response to a trigger event, such as inresponse to a value of a measured parameter (e.g., pressure, fluidamount, bioimpedance, heart rate, breathing rate, patient activitylevel, organ dimension, etc.) or in response to a user input requestingpumping. The pump can thus be configured to only periodically pumpfluid, e.g., only periodically run so as to alternate between periods inwhich the pump is running to provide fluid flow and in which the pump isnot running. Running periodically can help conserve power (e.g., batterypower, electrical power, etc.) and/or can be appropriate for patientswith lower risks of developing edema and/or for patients who tend to bemore at risk of developing edema at certain times (e.g., during the dayinstead of at night, when exercising, etc.) instead of having a moreconstant risk. In at least some embodiments, the pump can be configuredto be selectively switched between a continuous mode in which the pumpruns continuously and a periodic mode in which the pump runsperiodically, which can help the pump be most effectively used accordingto each patient’s current needs.

In an exemplary embodiment, in use, the pump can include an inflow portcoupled to an inflow tube in fluid communication with a lymphatic vesselof the patient, and can include an outflow port coupled to an outflowtube in fluid communication with a vein of the patient (e.g., thepatient’s subclavian vein, internal jugular vein, innominate vein (alsoreferred to as a “brachiocephalic vein”), or superior vena cava). Thepump can thus be configured to pump fluid from the lymphatic vessel tothe vein so as to facilitate removal of fluid from the lymphatic vesseland thereby facilitate higher lymphatic return by lowering outflowpressure at the lymphatic vessel. Because lymphatic systems can havedifferent anatomies in different patients, the inflow tube can bepositioned to be in fluid communication with the patient’s lymphaticduct, the patient’s thoracic duct, or any duct that drains into thepatient’s subclavian vein, jugular vein, innominate vein, or superiorvena cava.

FIGS. 1 and 2 illustrate one embodiment of a pump 10 configured to beimplanted in a body of a patient. The pump 10 can have a variety ofsizes, shapes, and configurations. In an exemplary embodiment, the pump10 can include any one of a pulsatile pump, a periodical pump, and acontinuous flow pump.

The pump 10 can have a size configured to facilitate implantation of thepump 10 within the patient’s lung. In at least some embodiments, thepump 10 can have a size configured to allow the pump 10 to be implantedwithin a vein of the patient. In at least some embodiments, the pump 10can have a size too large to be implanted with the patient’s vein andsmall enough to be implanted within a duct of the patient, e.g., athoracic duct of the patient or a lymphatic duct of the patient. In anexemplary embodiment, the pump 10 can have a length in a range of about2 to 3 cm and a diameter of about 20 mm.

The pump 10 can be configured to pump fluid at a rate that facilitatesdraining of fluid (e.g., lymph) from the patient’s lymphatic vessel. Inan exemplary embodiment, the pump 10 can be configured to pump fluid ata rate in a range of about 10 to 1000 ml/hour, e.g., in a range or about10 to 200 ml/hour, about 10 ml/hour, about 60 ml/hour, up to about 200ml/hour, etc. In at least some embodiments, the pump 10 can have astatic, e.g., unchangeable, flow rate. The flow rate can thus bepredictable and/or chosen for a specific patient. In other embodiments,the pump 10 can have an adjustable flow rate. The flow rate beingadjustable can help the pump 10 accommodate changes in the patient’scondition over time. The flow rate can be adjustable in a variety ofways, as will be appreciated by a person skilled in the art, such as bybeing wirelessly adjusted using a user-operated control device locatedexternal to the patient and configured to wirelessly communicate withthe pump 10 to adjust the flow rate thereof.

The pump 10 can include an inflow port configured to be coupled to aninflow tube (not shown), and can include an outflow port configured tobe coupled to an outflow tube (not shown). The inflow and outflow tubescan each be removably coupled to their respective ports of the pump 10or can each be permanently coupled to their respective ports. The inflowand outflow tubes can each be flexible to facilitate their positioningwithin tortuous and/or curved lumens in the patient’s body. The inflowand flexible tubes can each include, e.g., indwelling catheters. In anexemplary embodiment, both of the inflow and outflow tubes are coupledto the pump 10 in a same manner, e.g., both removable or both permanent.As will be appreciated by a person skilled in the art, fluid can beconfigured to flow in to the pump 10 through the inflow port and out ofthe pump 10 through the outflow port, thereby facilitating pumping ofthe fluid.

The pump 10 can be powered in a variety of ways. In at least someembodiments, the pump 10 can be configured to be powered by animplantable power source. In this illustrated embodiment, the pump 10 iscoupled to a power lead 12, also shown in FIG. 3 , coupled to animplantable power source 14. The implantable power source 14 can have avariety of sizes, shapes, and configurations. In this illustratedembodiment, the power source 14 includes a single power source in theform of a battery, but the power source can have other forms and/or caninclude a plurality of power sources. The power source 14 can beincluded as part of the pump 10. Alternatively, as in this illustratedembodiment, the power source 14 can be a separate component from thepump 10 and can be configured to be in electronic communicationtherewith along a power line, e.g., the power lead 12, etc. The powersource 14 being a separate component from the pump 10 can allow thepower source 14 to be implanted at an anatomical location outside thepatient’s lung, which can allow the power source 14 to have a sizeand/or construction that may otherwise be difficult to accommodatewithin a lung, and/or can facilitate replacement of the power source 14(e.g., when the power source is depleted or is near depletion). In thisillustrated embodiment, the power source 14 is implanted in a shoulder16 of the patient, but the power source 14 can be implanted in otheranatomical areas, as will be appreciated by a person skilled in the art.

Instead of the power source 14 being implanted, in at least someembodiments, the pump 10 can be configured to be powered by a powersource located external to the patient. The externally-located powersource can allow for a more powerful and/or larger power source thanimplanted power sources, and/or can help reduce an amount of materialimplanted into the patient, which can help reduce chances ofcomplications. The pump 10 can be configured to wirelessly communicatewith the externally-located power source to receive power therefrom. Inat least some embodiments, the pump 10 can include a charging coilconfigured to inductively couple to the externally-located power sourceso as to receive power therefrom. In at least some embodiments, ahandheld device can include the externally-located power source and canconfigured to be moved in proximity of the pump 10 to wirelesslycommunicate therewith. In at least some embodiments, theexternally-located power source can be included as part of a wearableelement that the patient can wear, e.g., on a belt, on a necklace, etc.,to keep the power source in effective range of the pump 10.

The pump 10 can be configured to continuously pump fluid, e.g.,continuously pump fluid through the inflow port and out the outflowport. The pump 10 can thus be configured to continuously pump fluid outof the area at which an input opening of the inflow tube coupled to theinflow port is located, e.g., out of a lymphatic vessel of the patientsuch as the patient’s thoracic duct or lymphatic duct, and into the areaat which an output opening of the outflow tube coupled to the inflowport is located, e.g., into a vein of the patient such as the patient’ssubclavian vein, internal jugular vein, innominate vein, or superiorvena cava.

The pump 10 can be configured to periodically pump fluid, e.g., havealternating periods of pumping and no pumping. The pump 10 can beconfigured to periodically pump on a set schedule, e.g., alternatelypump for “X” minutes and not pump for “Y” minutes, where “X” and “Y” canbe equal or different. The set schedule can be preprogrammed into thepump 10, e.g., in a controller thereof (discussed further below). Theset schedule can be static or can be adjustable. The set schedule can beadjustable in a variety of ways, as will be appreciated by a personskilled in the art, such as by being wirelessly adjusted using auser-operated control device located external to the patient andconfigured to wirelessly communicate with the pump 10 to adjust thepumping schedule thereof. Having a set schedule can allow the pump 10 tobe relatively simple electronically and not require much processingcapability.

Instead of having a set pumping schedule, the pump 10 can be configuredto not pump (e.g., be in an idle state) until the occurrence of atrigger event. In other words, the pump 10 can have a default idle stateand can be configured to move between the default idle state and anactive state in which the pump 10 pumps fluid in response to the triggerevent. The trigger event can be manually controlled (e.g.,user-controlled) or can be dynamically controlled (e.g.,non-user-controlled). A manually controlled trigger event can include auser input to the pump 10 requesting pumping. The pump 10 can thus beconfigured for on-demand pumping. The user can therefore cause pumpingwhen desired (e.g., during a shortness of breath episode, when the usernotices a slight weight gain, etc.) which can help the pump 10 runefficiently and when most needed as determined by the user. The user caninclude the patient or another person, such as the patient’s doctor, thepatient’s caretaker, etc. The input can be provided to the pump 10 in avariety of ways. In an exemplary embodiment, the input can be providedwirelessly to the pump 10 using a user-operated control device locatedexternal to the patient and configured to wirelessly communicate withthe pump 10 to cause the pump 10 to start pumping (e.g., change the pump10 from the idle state to the active state) or to stop pumping (e.g.,change the pump 10 from the active state to the idle state).

In addition or in alternative to the pump 10 being configured topump/not pump in response to a manual trigger event, the pump 10 can beconfigured to dynamically switch between pumping and not pumping inresponse to a dynamic trigger event. A dynamic trigger event can includea value of a measured parameter being out of range as compared to athreshold value and/or threshold range of values. The parameter can bemeasured using a sensor (not shown) associated with the patient havingthe pump 10 implanted therein. Examples of sensors that can be used tomeasure a parameter include pressure sensors (e.g., central venouspressure (CVP) or other fluid pressure sensors, and blood pressuresensors), radio frequency transmitters and receivers, fluid sensors,bioimpedance sensors, heart rate sensors, breathing sensors, activitysensors, optical sensors. Pressure sensors can be placed, for example,in the patient’s venous system, in the patient’s heart, in the patient’sarterial system, and/or in the patient’s body at target anatomical sitesthat may suffer from an increase of interstitial fluid overload. Fluidsensors can be placed, for example, in the lungs. Examples of themeasured parameter include pressure (e.g., as measured by a pressuresensor), fluid amount (e.g., as measured by a fluid sensor),bioimpedance (e.g., as measured by a bioimpedance sensor), heart rate(e.g., as measured by a heart rate sensor), breathing rate (e.g., asmeasured by a breathing sensor), patient activity level (e.g.,. asmeasured by an activity sensor), and organ dimension (e.g., as measuredby an optical sensor). The sensor can be implanted in the patient aspart of the pump 10, implanted in the patient as a separate componentfrom the pump 10 (e.g., implanted in an interstitial space around thelung, implanted at a junction of 20 of a right subclavian vein 22 of thepatient and an internal jugular vein 24 of the patient, implanted at ajunction (not shown) of a left subclavian vein (not shown) of thepatient and the internal jugular vein 24, etc.), or the sensor can belocated external to the patient, such as by being on a skin surfacethereof. If not already a part of the pump 10 so as to be in electroniccommunication therewith, the sensor can be configured to be inelectronic communication with the pump 10 over a communication line suchas a wired line or a wireless line. The sensor can include one or moresensors. In embodiments including a plurality of sensors, each of thesensors can be configured to measure the same parameter as or adifferent parameter than any one or more of the other sensors.

In at least some embodiments, the pump 10 can be configured to changeits pumping rate (e.g., from zero to a non-zero value, from a non-zerovalue to zero, or from one non-zero value to another non-zero value)based on pressure measured by a pressure sensor. If the measuredpressure exceeds a predetermined threshold maximum pressure value, thepump 10 can be configured to increase its pump rate (e.g., increase fromzero or increase from some non-zero value) in an effort to decrease thepressure.

In at least some embodiments, the pump 10 can be configured to changeits pumping rate (e.g., from zero to a non-zero value, from a non-zerovalue to zero, or from one non-zero value to another non-zero value)based on a fluid amount measured by a fluid sensor. If the measuredfluid amount exceeds a predetermined threshold maximum fluid amountvalue, the pump 10 can be configured to increase its pump rate (e.g.,increase from zero or increase from some non-zero value) in an effort todecrease the amount of fluid present.

In at least some embodiments, a fluid sack (not shown) can be implantedwithin the patient to facilitate continuous pumping of the pump 10. Thefluid in the sack can be in fluid communication with the inflow andoutflow ports of the pump 10. The fluid in the sack can include abiocompatible fluid such as saline and can include a coagulationmedication. The biocompatible fluid can generally serve as a carrier forthe coagulation medication. The coagulation medication can facilitatelong term patency of the pump 10 by allowing circulation through thesystem when more robust pumping by the pump 10 is not required. The pump10 can thus be configured to continuously pump at different rates, withthe different rates being changed in response to trigger events such asthose discussed above with respect to periodic pumping.

The pump 10 can include only a continuous mode of operation such thatthe pump 10 can only continuously pump fluid, the pump 10 can includeonly a periodic mode of operation such that the pump 10 can onlyperiodically pump fluid, or the pump 10 can include the continuous andperiodic modes of operation and be configured to be selectively switchedbetween the continuous mode of operation and the periodic mode ofoperation. The mode switching can be accomplished in a variety of ways,as will be appreciated by a person skilled in the art such as by beingwirelessly switched using a user-operated control device locatedexternal to the patient and configured to wirelessly communicate withthe pump 10 to change the mode of operation thereof.

A controller (e.g., a processor, a microcontroller, etc.) in electroniccommunication with the pump 10 can be configured to facilitate controlof the pump 10, e.g., control changing the pump’s mode of operation,etc. The controller can be included as part of the pump 10 so as to beconfigured to be implanted in the patient with the pump 10, or, as inthis illustrated embodiment, the controller can be a separate componentfrom the pump 10. The controller being part of the pump 10 can helpallow the pump 10 to be a self-contained system, although in such acontroller requires space in the pump 10, which can increase a size ofthe pump 10. The controller being a separate component from the pump 10can help the pump 10 have a smaller size and/or can allow the pump 10 tobe controlled by a more powerful processor since the processor can bemore easily upgraded than if implanted with the pump 10 and/or since theprocessor’s size can be less important when outside the pump 10 asopposed to inside the pump 10.

FIG. 4 illustrates an embodiment of a control system 200 configured tofacilitate control of a pump 203, e.g., the pump 10 of FIG. 1 or anyother pump disclosed herein, implanted in a patient. In general, thecontrol system 200 can include a controller (not shown) configured tocontrol the operation of an edema treatment system 201. The controllercan include any type of microprocessor or central processing unit (CPU),including programmable general-purpose or special-purposemicroprocessors and/or any one of a variety of proprietary orcommercially available single or multi-processor systems. The controlsystem 200 can also include any of a variety of additional components,such as a memory configured to can provide temporary storage and/ornon-volatile storage; a bus system; a network interface configured toenable the control system 200 to communicate with other devices, e.g.,other control systems, over a network; and an input/output (I/O)interface configured to connect the control system 200 with otherelectronic equipment such as I/O devices 205 a, 205 b (e.g., a keyboard,a mouse, a touchscreen, a monitor, etc.) configured to receive an inputfrom a user. The control system 200 can be configured to electronicallycommunicate with sensors 209 a, 209 b, 209 c that can, as discussedherein, be used to help control the operation of the pump 203.

Referring again to the embodiment of FIGS. 1 and 2 , the pump 10 isshown implanted in a right lymphatic duct 18 of the patient. The pump 10can, however, be implanted in a variety of other anatomical locations,such as in a left lymphatic duct (not shown; also referred to as a“thoracic duct”) of the patient. For reference, FIG. 1 also illustratesa right innominate vein 26 of the patient. The pump 10 can be implantedin a subcutaneous pocket created for the pump 10, which can help ensurethat the pump 10 has adequate space within the patient’s body.

In an exemplary embodiment, the pump 10 can be implanted adjacent thejunction 20 of the right subclavian vein 22 of the patient and theinternal jugular vein 24 of the patient (as in this illustratedembodiment) or adjacent the junction (not shown) of the left subclavianvein of the patient and the internal jugular vein 24. The junction 20 ofthe right subclavian vein 22 and the internal jugular vein 24 and thejunction of the left subclavian vein and the internal jugular vein 24are where the patient’s thoracic and lymphatic ducts drain. For patientsat risk of developing edema, outflow pressure at the junction 20 of theright subclavian vein 22 and the internal jugular vein 24 and at thejunction of the left subclavian vein and the internal jugular vein 24are typically highly elevated, e.g., to values greater than about 10mmHg, over normal outflow pressure, e.g., about 5 mmHg. Pressures inexcess of about 25 mmHg can completely stop lymphatic return, and duringchronic elevations of pressure, lymphatic flow can be much greater than25 mmHg. Providing the pump 10 adjacent one of these junctions can thushelp regulate fluid thereat, thereby helping to prevent edema fromoccurring. The pump 10 can be configured to regulate the pressure at thejunction to which it is adjacent to a safe, non-edemic level such as itsnormal level, e.g., about 5 mmHg, or within a range of about 2 to 6mmHg. With the pump 10 located in the left or right lymphatic ductadjacent one of the junctions, the pressure regulation can be performedfrom within the body’s natural fluid flow system, thereby allowing thepump 10 to pump at a relatively low flow rate to achieve the normalpressure level, e.g., a flow rate in a range or about 10 to 200 ml/hour,about 10 ml/hour, about 60 ml/hour, up to about 200 ml/hour, etc. Thisrelatively low flow rate corresponds to a relatively low pressureincrease on the fluid discharged into the patient’s venous circulationfrom the outflow tube in fluid communication with the pump’s outputport. The pressure gradient that that pump 10 discharges against is lessthan about 15 mmHg. This relatively low flow rate and this pressuregradient can allow the pump 10 to function with a very low energyconsumption (e.g., with a low drain on the power source 14), can allowfor a very small power source (e.g., a very small battery such as thoseused with pacemakers and implantable cardioverter-defibrillators(ICDs)), and/or can allow for the pump 10 to be very small and therebyfacilitate implantation thereof.

FIG. 5 illustrates another embodiment of a pump 100 configured to beimplanted in a body of a patient. The pump 100 can generally beconfigured and used similar to the pump 10 of FIGS. 1 and 2 . In thisillustrated embodiment, the pump 100 is shown implanted in a patient. Aninflow tube 102 coupled to an inflow port 104 of the pump 100 is influid communication with a right lymphatic duct 106 of the patient byhaving an inflow opening 108 thereof positioned to receive fluidtherefrom, e.g., by being positioned within the right lymphatic duct106. The inflow tube 102 extends from the right lymphatic duct 106 andthrough the patient’s subclavian vein 110 to the pump 100. Forreference, FIG. 5 also shows the patient’s internal jugular vein 112 andright innominate vein 114. An outflow tube 116 coupled to an outflowport 118 of the pump 100 is in fluid communication with the subclavianvein 110 by having an outflow opening 120 thereof positioned to releasefluid from the outflow tube 116 into the subclavian vein 110, e.g., bybeing positioned within the subclavian vein 110. FIG. 5 also indicatesan area 122 of low pressure zone created by the pump 100, e.g., bypumping fluid out of the lymphatic duct 106, at the lymphatic duct 106.

FIG. 6 illustrates yet another embodiment of a pump 300 configured to beimplanted in a body of a patient. The pump 300 can generally beconfigured and used similar to the pump 10 of FIGS. 1 and 2 . In thisillustrated embodiment, the pump 300 is shown implanted in a lung of apatient. An inflow tube 302 coupled to an inflow port 304 of the pump300 is in fluid communication with an internal jugular vein 306 of thepatient and a right subclavian vein 308 of the patient by having aninflow openings 310 a, 301 b thereof positioned to receive fluidtherefrom. For reference, FIG. 6 also shows the patient’s rightlymphatic duct 312 and location 312 a of the lymphatic duct’s outflow.An outflow tube 314 coupled to an outflow port 316 of the pump 300 is influid communication with a brachiocephalic vein 318 of the patient byhaving an outflow opening 320 thereof positioned to release fluid fromthe outflow tube 314 into the brachiocephalic vein 318. FIG. 6 alsoindicates an area 322 of low pressure zone created by the pump 300.

FIG. 6 also illustrates an embodiment of a sensor 324, a pressure sensorin this illustrated embodiment, configured to be implanted in the bodyof the patient. The sensor 324 can be configured to electronicallycommunicate with the pump 300 via a communication line 326, whichincludes a wire in this illustrated embodiment. In this illustratedembodiment, the sensor 324 is implanted outside the inflow and outflowtubes 302, 314 and adjacent the location 312 a of the right lymphaticduct’s outflow at a junction of the right subclavian vein 308 and thejugular vein 306. The sensor 324 can thus be configured to sensepressure at the junction, and the pump 300 can be configured to pump inresponse to the pressure sensed by the sensor 324 as discussed herein.

The embodiment of FIG. 6 can be effective to treat chronic pulmonaryedema and can be effective to treat acute pulmonary edema. Variousembodiments of systems and methods of treating acute pulmonary edema aredescribed in U.S. App. No. 14/625,930 entitled “System And Method ForTreating Pulmonary Edema” filed Feb. 19, 2015, which is herebyincorporated by reference in its entirety.

FIG. 7 illustrates still another embodiment of a pump 400 configured tobe implanted in a body of a patient. The pump 400 can generally beconfigured and used similar to the pump 10 of FIGS. 1 and 2 . In thisillustrated embodiment, the pump 400 is shown implanted in a lung of apatient. An inflow tube 402 coupled to an inflow port (not shown) of thepump 400 is in fluid communication with an thoracic duct 404 of thepatient by having an inflow opening 414 thereof positioned to receivefluid therefrom. An outflow tube 406 coupled to an outflow port (notshown) of the pump 400 is in fluid communication with a left subclavianvein 408 of the patient by having an outflow opening 410 thereofpositioned to release fluid from the outflow tube 406 into the leftsubclavian vein 408. For reference, FIG. 7 also illustrates a rightlymphatic duct 416 of the patient.

FIG. 7 also illustrates an embodiment of a sensor 412, a pressure sensorin this illustrated embodiment, configured to be implanted in the bodyof the patient. The sensor 412 can be configured to electronicallycommunicate with the pump 400 via a communication line. In thisillustrated embodiment, the sensor 412 is implanted outside the inflowand outflow tubes 402, 406 and in an interstitial space of the patient’slung. The sensor 412 can thus be configured to sense pressure in thelung cavity, and the pump 400 can be configured to pump in response tothe pressure sensed by the sensor 412 as discussed herein.

FIG. 8 illustrates still another embodiment of a pump 600 configured tobe implanted in a body of a patient. The pump 600 can generally beconfigured and used similar to the pump 10 of FIGS. 1 and 2 . In thisillustrated embodiment, the pump 600 is shown implanted in a lung of apatient. As illustrated, an inflow tube 602 having an inflow opening 604can be coupled to an inflow port 606 of the pump 600, and an outflowtube 608 having an outflow opening 610 can be coupled to an outflow port612 of the pump 600. For reference, FIG. 8 also shows the patient’s leftsubclavian vein 614 and thoracic duct 616. The pump 600 in thisillustrated embodiment is implanted at a location where the thoracicduct 616 connects with the left subclavian vein 614, but the pump 600can be implanted elsewhere, as discussed herein.

As illustrated, the pump 600 can include an impeller, which is a type ofrotor pump. In an exemplary embodiment, the pump 600 can have a diameterin a range of about 1 to 5 mm, which can facilitate its implantationwithin a small body space as discussed above, and can be configured topump fluid at a rate in a range of about 10 to 100 ml/min. The pump 600can include therein a power source (not shown) such as a battery, acontroller (not shown) such as a microprocessor or other miniaturecontrol electrical board, and a motor 618 configured to drive the pump600. The pump 600 can be configured to be activated manually foron-demand pumping and/or to be activated automatically in response to adynamic trigger, as discussed above.

The pump 600 can be used in a variety of methods for treating pulmonaryedema, as discussed further below. In general, the pump 600 can beimplanted in the patient via a mini thoracotomy (similar to a pacemakerimplantation procedure or ICD implantation procedure) and advanced tothe location where the thoracic duct 616 connects with the leftsubclavian or jugular veins 614, 620. The motor 618 that drives the pump600 can be implanted in a subcutaneous pocket located below a shoulderbone, similar to pacemaker devices. Before the implantation of the pump600, the thoracic duct 616 can be located using a guide wire insertionvia the subclavian or jugular veins. Once inside, the pump 600 can beadvanced to the venous angle, and the guide wire (not shown) can bemanipulated until the thoracic duct 616 is found and entered. Once thethoracic duct 616 is found, the guide wire can be kept in place insidethe thoracic duct, and the pump 600 can be advanced to the locationwhere the inflow tube 602 is in the vein 614 with the inflow opening 604thereof as close as possible to the thoracic duct 616. Once the pump 600is activated (manually or automatically), blood can be sucked thereinand advanced to the brachiocephalic vein. Around the inflow opening 604of the pump 600 a low pressure zone will be created, thereby allowingfor the lymphatic fluids to flow more easily and thus reduce the edema.

FIG. 9 illustrates yet another embodiment of a pump 700 configured to beimplanted in a body of a patient. The pump 700 can generally beconfigured and used similar to the pump 10 of FIGS. 1 and 2 . Asillustrated, an inflow tube 702 having an inflow opening 704 can becoupled to an inflow port 706 of the pump 700, and an outflow tube 708having an outflow opening 710 can be coupled to an outflow port 712 ofthe pump 700. For reference, FIG. 9 also shows the patient’s leftsubclavian vein 714, thoracic duct 716, and jugular vein 718. The pump700 in this illustrated embodiment generally provides a bypass from thethoracic duct 716 to the left subclavian vein 714, thereby allowing fora constant draining option for the lymphatic duct in case venouspressures elevate. The pump 700 can thus be configured to beautomatically activated to drain fluid on demand in response to ameasured increase in pressure. A bypass can be similarly provided bypositioning the outflow opening 710 at the jugular vein 718 instead ofthe left subclavian vein 714.

FIG. 10 illustrates an embodiment of an implantable restrictor 800configured to be implanted in a body of a patient. The restrictor 800can be configured to restrict fluid flow to facilitate draining of fluid(e.g., lymph) from the patient’s lymphatic vessel, similar to the pumpsdescribed herein. The restrictor 800 can generally have a size similarto the pumps described herein, and can be configured to be implanted ina patient’s body at locations described herein for the pumps.

As illustrated, the restrictor 800 can include a balloon 802 configuredto move between an activated configuration, shown in FIG. 11 , in whichthe balloon 802 is inflated and a motor 804 coupled to the restrictor800 is activated to cause the inflation, and a relaxed configuration,shown in FIG. 12 , in which the balloon is deflated and the motor 804 isnot activated to allow the balloon 802 to assume its default, deflatedconfiguration. In the activated configuration, the restrictor 800 canrestrict fluid flow above the balloon 802 and consequently increasefluid flow velocity, e.g., induce the Venturi effect. The restrictor 800is shown fully deflated in FIG. 11 and fully relaxed in FIG. 12 . Theballoon 802 can have any number of partially deflated configurationsbetween the fully deflated and fully relaxed configurations. Therestrictor 800 can include anchors 806 on either end of the balloon 802to help secure the balloon 802 in position within the patient’s body. Inthis illustrated embodiment, the restrictor 800 is implanted just abovethe patient’s venous angle, where the thoracic duct 808 is located,thereby allowing pressure to be reduced around the venous angle. Therestrictor 800 can be similarly implanted on a right side of a patient.

FIG. 13 illustrates another embodiment of an implantable restrictor 900configured to be implanted in a body of a patient. The restrictor 900can generally be configured and used similar to the restrictor 800 ofFIGS. 10-12 . The restrictor 900 can include a pair of external clips902 configured to clip to an exterior of the subclavian or jugular veinadjacent the lymphatic or thoracic duct. The restrictor 900 can beconfigured to constantly restrict fluid flow through a fluid pathway 908defined at its terminal ends by the clips 902. In other words, therestrictor 900 can be configured to provide a permanent low pressurezone (until and if the restrictor 900 is removed from the patient’sbody). In this illustrated embodiment, the restrictor 900 is attached toan exterior of the patient’s left subclavian vein 904 adjacent thepatient’s thoracic duct 906.

The pumps described herein can be used in a variety of methods fortreating pulmonary edema. FIG. 14 illustrates one embodiment of a method500 for treating pulmonary edema that can be performed using a pumpdisclosed herein, e.g., the pump 10 of FIG. 1 , the pump 100 of FIG. 5 ,the pump 300 of FIG. 6 , the pump 400 of FIG. 7 , etc.

The method 500 can include creating 502 a subcutaneous pocket in apatient to contain an implantable pump therein. The subcutaneous pocketneed not be created if the patient already has a location therein thatcan safely accommodate the pump. The pump can be implanted 504 in thepatient, either in the created subcutaneous pocket or elsewhere.

The method 500 can include verifying 506 a location of the patient’sthoracic duct and/or the patient’s lymphatic duct, which can help asurgeon and/or other medical professional involved in performing asurgical procedure that includes implanting 504 the pump verify that thepump, an inflow tube coupled to the pump, and/or an outflow tube coupledto the pump are implanted in the correct location within the patient. Ifany one or more of the pump, the inflow tube, and the outflow tube isbeing implanted 504 in one of the patient’s thoracic duct and/or thepatient’s lymphatic duct, the location at least that one of the thoracicduct and lymphatic duct can be verified 506 to help ensure that thepump, the inflow tube, and/or the outflow tube are implanted 504 at thedesired location.

The verification 506 can be performed in any of a variety of ways, aswill be appreciated by a person skilled in the art, such as by using animaging technique such as echo or fluoroscopy. In an exemplaryembodiment, the verification 506 can include advancing a set of pigtailed wires into the patient’s subclavian or jugular veins and advancedtoward a junction of the jugular and subclavian veins. Once one of thepig tailed wires enters the lymphatic duct or the thoracic duct, thatone of the pig tailed wires can open itself inside the duct it entered,e.g., due to a default expanded configuration of the wire. The pigtailed wires can include, for example, a default expanded circle size of4 cm. The location of the entered duct can be verified using an imagingtechnique that visualizes the expanded wire therein.

FIG. 14 shows the verification 506 occurring after the implantation 504of the pump such that the implanted location of the pump can bedetermined in view of the verification 506 and adjusted if need be inview of the verification 506. Additionally or alternatively, theverification 506 can be performed prior to the implantation of the pump.Similarly, the verification 506 can be performed prior to and/or afterthe inflow and outflow tubes are positioned 508 in the patient such thattheir respective inflow and outflow openings are desirably positioned,and the verification 506 can be performed prior to and/or after a sensoris implanted 510 in the patient such that their respective inflow andoutflow openings are desirably positioned. As discussed above, thesensor in some embodiments is not implanted and is instead locatedoutside the patient’s body, and/or at least one sensor is implanted 510and at least one sensor is located outside the patient’s body. Theinflow and outflow tubes can be positioned 508 in a variety of ways, aswill be appreciated by a person skilled in the art, such as by using acentral line procedure. Positioning tubes such as catheters is furtherdescribed in previously mentioned U.S. App. No. 14/625,930 entitled“System And Method For Treating Pulmonary Edema” filed Feb. 19, 2015.

Although not shown in FIG. 14 , the method 500 can in at least someembodiments include implantation of a fluid sack either with theimplantation 504 of the pump when the fluid sack is a part thereof or asa separate implantation if the fluid sack is a separate component fromthe pump.

With the pump implanted 504, the inflow and outflow tubes positioned508, and, if being used in the system, the sensor implanted 510 and/orthe fluid sack implanted, fluid flow can be controlled 512 with thepump. The control 512 can generally occur as described above. In atleast some embodiments, controlling 512 the pump can includecontinuously running the pump. In at least some embodiments, controlling512 the pump can include periodically running the pump. FIG. 15illustrates one embodiment of controlling 512 the pump to periodicallyrun. The pump can default to an idle state 514 in which the pump is notpumping fluid. In response to receipt 516 of a user input requestingpumping, e.g., input by a user to an I/O device in electroniccommunication with the pump via a control system, input wirelessly tothe pump, etc., the pump can be actuated so as to run 518 and pumpfluid. The pump can continue pumping until occurrence of a stopcondition 520. Examples of the stop condition include a predeterminedamount of time passing after the pump starts running 518 and a seconduser input being received that requests pumping to stop. In response tothe stop condition 520 occurring, the pump can be actuated to return 522to its idle state 514.

FIG. 16 illustrates another embodiment of controlling 512 the pump toperiodically run. A parameter can be measured 524 with a sensor (eitherthe implanted 510 sensor or an externally-located sensor), and the pumpcan be actuated 528 to run in response to a value of the measuredparameter being determined 526 (e.g., by a controller executing analgorithm) to be greater than a predetermined threshold value. Theparameter can continue being measured 524 with the sensor, therebyallowing the pump to continue running until the measured parameter isdetermined 526 to be less than the predetermined threshold value. Inresponse to the parameter being determined 526 to be less than thepredetermined threshold value, the pump can be stopped 530, if it isrunning, and the parameter can continue being sensed to either keep thepump off or turn it back on 528.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A system for treatment of edema, comprising: apump configured to be implanted in a body of a patient; an inflow tubefluidically coupled to an inflow port of the pump and configured to beimplanted into the body of the patient so as to bring the inflow portinto fluid communication with a lymphatic vessel of the patient; and anoutflow tube fluidically coupled to an outflow port of the pump andconfigured to be implanted into the body of the patient so as to bringthe outflow port into fluid communication with a vein in the body of thepatient such that the pump is operative to pump fluid from the lymphaticvessel to the vein.
 2. The system of claim 1, further comprising acontroller configured to actuate the pump.
 3. The system of claim 2,wherein the controller is configured to actuate the pump in response touser operation of a control external to the body of the patient.
 4. Thesystem of claim 2, further comprising a pressure sensor configured to beimplanted in the body of the patient, the controller being configured toactuate the pump in response to a pressure measured by the pressuresensor exceeding a predefined threshold.
 5. The system of claim 2,further comprising a pressure sensor configured to be implanted in thebody of the patient, the controller being configured to control a speedof operation of the pump depending on a pressure measured by thepressure sensor.
 6. The system of claim 1, wherein the pump isconfigured to continuously pump the fluid from the lymphatic vessel tothe vein.
 7. The system of claim 1, further comprising a power sourceconfigured to be implanted in the body of the patient and configured toprovide power to the pump.
 8. The system of claim 1, further comprisinga charging coil configured to inductively couple to a power sourceexternal to the body of the patient and thereby provide power to thepump.
 9. The system of claim 1, wherein the pump includes a pulsatilepump.
 10. The system of claim 1, wherein the pump is configured to pumpfluid at a rate in a range of about 10 to 1000 ml/hour.
 11. The systemof claim 1, wherein the pump is configured to pump fluid at a rate in arange of about 10 to 200 ml/hour.
 12. A method of treating edema,comprising: implanting a pump in a body of a patient, the pump beingoperable to convey a bodily fluid from an inflow port of the pump to anoutflow port of the pump; arranging a first tube in fluid communicationwith the inflow port to be in fluid communication with a lymphaticvessel of the patient; and arranging a second tube in fluidcommunication with the outflow port to be in fluid communication with avein of the patient such that the pump is operable to convey fluid fromthe lymphatic vessel to the vein.
 13. The method of claim 12, furthercomprising actuating the pump, thereby causing the pump to convey thefluid from the lymphatic vessel to the vein of the patient, the fluidincluding lymph.
 14. The method of claim 13, wherein the actuated pumpmaintains an outflow pressure in a range of about 2 to 6 mmHg.
 15. Themethod of claim 13, wherein the pump is actuated in response to useroperation of a control external to the body of the patient.
 16. Themethod of claim 13, wherein the pump is configured to be actuatedperiodically or continuously.
 17. The method of claim 12, wherein thelymphatic vessel includes one of a thoracic duct of the patient and alymphatic duct of the patient.
 18. The method of claim 12, wherein thevein includes one of the patient’s subclavian vein, internal jugularvein, innominate vein, and superior vena cava.
 19. The method of claim12, further comprising implanting a pressure sensor in a location withinthe body of the patient that enables the pressure sensor to measurepressure in a desired region of the body of the patient.
 20. The methodof claim 19, further comprising measuring the pressure in the desiredregion using the pressure sensor, and actuating the pump in response tothe measured pressure exceeding a predefined threshold.
 21. (canceled)22. (canceled)